Is it time to target no evident disease activity (NEDA) in multiple sclerosis?

Area of Science:

• Neuroimmunology
• Clinical Neurology
• Translational Medicine

Background:

• Multiple sclerosis (MS) management is increasingly complex due to novel disease-modifying therapies (DMTs).
• Current treatment strategies may not be optimally individualized for all MS patients.
• The emergence of highly effective DMTs necessitates refined treatment paradigms.

Purpose of the Study:

• To propose a new, individualized treatment paradigm for multiple sclerosis management.
• To define and implement a treat-to-target strategy based on no evident disease activity (NEDA).
• To outline an algorithm for switching or escalating therapies based on treatment response.

Main Methods:

• Individualized treatment selection between maintenance-escalation or induction therapy.
• Treat-to-target approach aiming for no evident disease activity (NEDA) using clinical and MRI criteria.
• Active monitoring including rebaselining and annual MRI studies to detect subclinical relapses.

Main Results:

• Disease activity on maintenance-escalation therapy suggests sub-optimal response, prompting therapy adjustment.
• Disease activity on induction therapy indicates a need for retreatment or a switch to maintenance-escalation.
• The proposed algorithm provides a framework for dynamic treatment adjustments in MS.

Conclusions:

• The proposed treatment paradigm individualizes MS management by targeting NEDA.
• Active monitoring and defined criteria guide therapeutic decisions for optimal outcomes.
• The definition of NEDA is expected to evolve with technological advancements, enhancing treatment personalization.